A tophus (plural: tophi) is a deposit or lump of uric acid crystals that forms in people with gout, a type of arthritis. Tophus means "stone" in Latin. Gout is a condition where the body has overly high levels of uric acid in the blood, either because it can not rid itself of, or produces too much uric acid.

Uric acid is a naturally occurring chemical produced when the body breaks down purines, an organic compound found in the body and in most foods. In normal quantities, uric acid is a natural and healthy antioxidant, helping to prevent damage to blood vessels.

But when too much uric acid circulates in the blood it builds up, forming painful needle-like crystals and, in some cases, knobby, chalky lumps called tophi. Uric acid can also accumulate in the kidneys, causing kidney stones, or, less frequently, in the tendons or other organs.

It's estimated about 25 percent of people with gout will eventually develop tophi. Tophi usually take many years to develop, appearing about 10 years after the onset of untreated or poorly managed gout, although they may appear earlier or later. They appear most often in the elderly, especially elderly women.

Tophi can form under the skin or in the joints, bones and cartilage. They commonly occur on the ears, fingers, toes, ankle and elbow. They first form as movable lumps, and become whitish and painful as they grow bigger. Gout sufferers often develop more than one tophi.

If allowed to continue to grow, tophi can deform and destroy joints and cartilage. They can also become infected and burst, oozing through the skin or causing a life threatening bacterial infection in the blood.

Tophi can be reabsorbed into the body if uric acid levels are decreased. Therefore they are treated by reducing the body's level of uric acid with gout medication. This can take months, or even years. Febuxostat (brand name Uloric) and pegloticase (brand name Krystexxa) are two of the most effective uric acid reducing tophi and gout medications.

Gout medications must be taken with care however, as the reabsorption of a tophus can raise uric acid levels in the blood, precipitating a gout attack. In some cases, tophi will need to be removed surgically.

Gout now affects over 8 million Americans - about 6% of men, and 2% of women. A "pre-gout" condition called hyperuricemia
(high blood levels of uric acid) can be found in a startling 21% of the population.

The soaring incidence of gout in Americans over the last 20 years has led researchers to analyze US National Health and Nutrition Examination Survey data to try and understand what's behind the increase in this painful form of arthritis.

The analysis established links between gout, obesity and high blood pressure. Earlier studies have linked gout to metabolic syndrome, a cluster of conditions including obesity, high blood pressure, insulin resistance and high cholesterol.

Better control of these conditions is key to preventing and treating gouty arthritis. Gout is a chronic condition, but can be successfully managed with lifestyle changes and gout medication such as anti inflammatories, prescription
colchicine and uric acid reducers.

Cases of gout in Americans are on a decades long upswing. In fact, the incidence of gout doubled between the 1960s and the 1990s, and is continuing to climb. Gout, or gouty arthritis, is one of the most painful types of arthritis. It accounts for about 5 percent of arthritis cases, effecting almost 850 out of every 100,000 Americans. Gout is nine times more common in men than in women, and tends to hit between the ages of 40 and 50.

A new online resource, www.Colchicine.ca, has been created to help educate Americans on the symptoms, causes, prevention and treatment of gout. Untreated or inadequately treated gout is not only extremely painful; it can permanently damage and disfigure joints and tissue.

Gout is caused by a build up of uric acid in the joints. The excess uric acid forms needle sharp crystals that irritate and inflame the cartilage around the joints, usually at the base of the big toe. Gout is characterized by a sudden onset of intense pain, swelling, redness, heat and stiffness. Many gout sufferers can not even bear the weight of a bed sheet on their foot during an attack.

Colchicine is considered one of the most effective gout medications, but the price of colchicine in the US has soared from about 5 cents a colchicine tablet to almost $5 a tablet since the FDA's Unapproved Drug Initiative led to the removal of cheap generic colchicine from the market in 2010 in favor of the brand name colchicine Colcrys.

The new online resource contains a wealth of constantly updated information on gout, gout treatment and gout prevention not found in one place anywhere else, including:

- why gout is more dangerous in women than in men
- new developments in gout treatment
- affordable alternatives to high priced Colcrys
- gout medications and natural remedies for gout
- the connection between gout and diet
- gout myths and misconceptions
- links to gout quizzes, videos, newsletters and other resources

So if you or someone close to you is wondering what the heck is pseudogout or gout tophus, if goutweed is really an effective gout treatment, or how other gout sufferers are using baking soda and poultices to deal with the excruciating pain, check out Colchicine.ca.

The incidence of gouty arthritis doubled in the US between the 1960s and the 1990s, and that trend is continuing. Gout is feared as the most painful type of arthritis. It results from a build up of uric acid in the blood, which ends up deposited around the joint or joints in sharp, needle-like crystals, most often at the base of the big toe.

"Gout is the most common inflammatory arthritis in the US," says Dr. Tuhina Neogi, an associate professor at Boston University School of Medicine, "We have good gout medications that can potentially prevent attacks, yet people do still get attacks, with recurrent attacks being the biggest burden of gout."

While gout is considered a chronic, incurable disease, it can be managed with lifestyle changes and gout medications. Gout flare ups are highly associated with diet, particularly food rich in naturally occurring compounds called purines. Red meat, yeast, certain seafood and alcohol well-known gout triggers.

Researcher Neogi and her team were intrigued by earlier studies that found caffeine intake appeared to lower uric acid levels in the body over time, decreasing the risk of developing gout. But those studies were conducted with non-gout sufferers, and the team wondered about the effect of caffeine on people who already had gout.

Caffeine was of particular interest to the researchers because its chemical structure is very similar to a common uric acid lowering gout medication, allopurinol. While effective over time, allopurinol can trigger a gout attack in patients just starting to take the gout medicine.

This is because, as the uric acid crystals deposited in the joints begin to dissolve, they release uric acid into the blood stream. Neogi and her team wondered if caffeine might have the same short-term effect.

The team studied gout patients who drank caffeine-containing beverages like, coffee, tea, soft drinks and energy drinks. They found that caffeine "binges" did indeed trigger gout flare ups. In fact, gout patients who normally had a low caffeine intake who drank six caffeine containing drinks in a day tripled their risk of experiencing a gout attack within 24 hours.

However, those gout patients that normally drank more than two servings of caffeinated beverages a day had no reaction to increasing their consumption, much as a gout patient taking allopurinol for gout no longer experiences a flare up after the first few doses.

"I would not advise someone with gout to start drinking coffee as a way to lower uric acid levels due to its short-term effects," cautions Neogi. "People with gout who are already habitual caffeine drinkers probably don't need to change their habits, given that long-term caffeine intake can potentially lower uric acid levels. But the person who doesn't drink a lot of caffeine on a regular basis should be aware that drinking more than usual may potentially trigger an attack."

Gout is normally associated with portly historical figures such as King Henry the VIII. Benjamin Franklin missed several important meetings in which the Declaration of Independence was drafted due to gout flare ups, and had to be sent the documents to make his revisions.

But the rate of gout has doubled in the last 50 years, and remains on the rise. It now affects over 8 million Americans, most of them men, and many of them young and otherwise healthy, such as major league baseball pitcher Curt Schilling. Gout is considered the most painful form of arthritis and remains a chronic and incurable condition. Luckily, it can be managed with diet and gout medication.

Fellow pitcher David Wells said he gave a "high falsetto scream, like a six-year-old girl", when he woke up with his first attack of gout and stood up on the affected foot. To see which famous basketball player and soccer star suffer from gout, and which well known actor developed gouty arthritis after gaining 60 pounds for a role (ending up in a wheelchair), check out the Health.com slideshow, 8 Famous People With Gout.

Gouty arthritis patients who take NSAIDs (non-steroidal anti-inflammatory drugs) such as naproxen or celecoxib for relief of pain and inflammation should be aware of the results of a recent study conducted at McMaster University's Farncombe Family Digestive Health Research Institute.

Researchers discovered that those patients who take stomach acid lowering drugs called proton pump inhibitors (PPIs) such as Nexium or Prevacid with their NSAIDs to reduce the chance of stomach bleeding or ulcers are at risk of a different problem - major damage to the small intestine.

It turns out that PPIs may actually aggravate hard to detect damage done to the small intestine by NSAIDs. This damage has only recently been revealed by the use of mini video cameras that are swallowed like pills.

"Suppressing acid secretion is effective for protecting the stomach from damage caused by NSAIDs, but these drugs seem to be shifting the damage from the stomach to the small intestine, where the ulcers may be more dangerous and more difficult to treat," warns principal investigator Professor John Wallace.

The use of probiotics (live microorganisms) is now being considered as a possible treatment for injury to the small intestine. In the meantime, arthritis and gouty arthritis patients may want to reconsider their use of gout medications.

The American College of Rheumatology (ACR) joins organizations from around the world in celebrating World Arthritis Day. Held every year on October 12, this year's theme is "Move to Improve" - focusing on using physical activity to combat arthritis and rheumatic diseases - such as osteoarthritis, rheumatoid arthritis, lupus, gouty arthritis and psoriatic arthritis.

An estimated 50 million Americans — including nearly 300,000 children — are affected by arthritis and rheumatic diseases. People with these diseases who are inactive can have a variety of health risks, including type II diabetes and cardiovascular disease. In addition, decreased pain tolerance, weak muscles, stiff joints and poor balance common to many forms of arthritis can be made worse by inactivity.

Conversely, those who are physically active benefit from exercise and can experience improvement in pain, energy, sleep, and day-to-day functioning. In addition, people who are physically active are healthier, happier and live longer than those who are inactive and unfit, and this is especially true for people with arthritis. Despite these facts, arthritis is one of the most common reasons people give for limiting physical activity and recreational pursuits.

"Many people with arthritis and rheumatic diseases suffer from joint pain and stiffness, which can cause a person to avoid exercise out of the fear of increasing their pain or causing injury," says ACR President and practicing rheumatologist, David Borenstein, MD. "However, exercise — when properly planned and safely executed — can do just the opposite."

To create a safe, realistic and customized exercise plan, the ACR offers six tips:

Start by consulting with your rheumatologist.

Set realistic short and long term goals, and reward yourself when you have achieved them.

Exercise with a friend or family member.

Keep an exercise log or chart your progress on a calendar.

Create several exercise options and locations to keep from becoming bored.

Identify problems or obstacles that are likely to get in the way of your exercise program and plan ahead how you will deal with them.

Choose activities that are convenient, relatively inexpensive and fun.

"While there is no cure for arthritis, a healthy lifestyle that includes regular exercise can improve quality of life" explains Dr. Borenstein. "And, exercising can be very motivating and one of the easiest ways to combat pain from arthritis and rheumatic diseases."

In addition to celebrating World Arthritis Day, the ACR partners with the Arthritis Foundation on its Ad Council campaign to help people age 55 and up who have, or are at risk for developing, osteoarthritis discover movement as a weapon in the fight against arthritis. The campaign, "Fight Arthritis Pain," was created to increase the public's awareness that there are simple steps everyone can take to prevent and decrease the pain and disability of OA.

The American College of Rheumatology is an international professional medical society that represents more than 8,000 rheumatologists and rheumatology health professionals around the world. For more information about the ACR and rheumatology, visit http://www.rheumatology.org. For more information about the World Arthritis Day, visit http://www.worldarthritisday.org .

Dr. Sharon Oorange has written a blog post for the health and wellness website DailyStrength titled Eleven Things You Need to Know About Gout.

She states that the reason we are hearing so much about gout is that it has greatly increased in prevalence in the last 30 years. Dr Oorange goes on to list some of the most important things to know about gout, such as gout causes and gout symptoms.

She makes two important points about gout treatment:

1) Only 37% of gouty arthritis patients are taking their gout medications according to their doctor's instructions. (That number will likely increase now that generic colchicine is no longer available in the US, and the price of name brand Colcrys has soared).

2) A common mistake patients make is that symptoms of gout must resolve before they start on the gout drugs allopurinol or febuxostat, which are for prevention of gout attacks.

When squeezed in the vise of pain that is a gouty arthritis attack, most gout sufferers don't need to be told to avoid exercise - they do their utmost to avoid moving the painful joint (usually the big toe) at all costs. Even the pressure of a sock may be too much to bear.

Strenuous physical activity is not recommended during a gout flare-up, as it may irritate already inflamed joints. But exercising when you're not suffering from a gout attack helps to stop the build-up of uric acid, and exercises that improve range of motion can decrease gout symptoms.

Yoga, strength training, and simple stretching will help reduce stiffness and increase flexibility, and help rid the body of uric acid. A combination of gout medication such as prescription colchicine and exercises designed to increase mobility and maintain a healthy weight helps to control gout.

Gout has historically been considered "the rich man's disease", and thought to occur in older men who indulged in a lot of red meat and alcohol. But gout is no longer an older-person's condition or a man's disease - younger men and more women are also being affected by it.

What is causing this rise in younger people with gout? In an online news item on CBSLosAngeles.com, Rheumatologist Doctor Robert Harris, the Chair of the Board of Directors for the Arthritis Foundation's Pacific Region, says the main factors that trigger gout are obesity, high intakes of alcohol, high blood pressure and diabetes.

Dr. Harris says he is now seeing younger patients in their 30s, 40s and 50s with gouty arthritis. He says the main factors triggering gout in younger people and in women are obesity, high alcohol intake, high blood pressure and diabetes.

Harris says gout medication (such as prescription colchicine) is one way to treat gout, along with dietary changes such as avoiding high purine foods and alcohol. To read the article on gout in younger people on CBSLosAngeles.com, >Click Here.<

Two major American drug companies are racing to get rival new gout medications to market. Both gout drugs take novel approaches to treating refractory gout - gout that hasn't responded well to current treatment.

Ardea Biosciences was the first to announce successful clinical trials of its experimental gout drug RDEA594, also known as Lesinurad.
Lesinurad's mechanism of action is different from that of the commonly prescribed xanthine oxidase inhibitors gout medications (such as allopurinol and febuxostat), which decrease the production of uric acid.

Lesinurad is a URAT1 transporter inhibitor which increases elimination of uric acid through the kidneys. Lesinurad is also active against another important regulator of urate secretion, OAT4. OAT4 is thought to be responsible for the high uric acid levels in gouty arthritis patients whose condition is caused or worsened by diuretics.

The Lesinurad study involved 208 gout patients who had high blood urate levels for at least 6 months, even while taking the gout drug allopurinol. Patients continued on allopurinol and were randomly assigned to receive either a placebo or lesinurad at doses of 200 mg, 400 mg, or 600 mg for four weeks.

All three groups who were given lesinurad showed significantly lower uric acid levels at the end of the month. The percentage of patients who achieved the target for uric acid levels after treatment was 28% in the placebo group, 71% in the 200 mg group, 76% in the 400 mg group, and 87% in the 600 mg group.

More recently, shares of BioCryst Pharmaceuticals rose 12% upon the release of the results of its phase 2b randomized, double-blind, study of the investigational gout drug BCX4208. BCX4208 is a novel enzyme inhibitor that acts upstream of xanthine oxidase in the purine metabolism pathway to reduce serum uric acid (sUA).

Its mechanism of action complements xanthine oxidase inhibitors such as allopurinol and febuxostat in reducing uric acid production, and BCX4208 is intended as an add-on therapy for those gouty arthritis patients who don't respond well to current gout medication.

Like Lesinurad, BCX4208 was studied in gouty arthritis patients who had experienced high blood urate levels for at least 6 months, despite taking the gout drug allopurinol. The 279 study participants were randomly assigned to take BCX4208 at doses of either 5 mg, 10 mg, 20 mg, or 40 mg once daily for 12 weeks. One group of patients was given a placebo. All participants were also given allopurinal 300 mg once-daily.

All but one of the doses showed that BCX4208 was superior to the placebo when taken with allopurinol. The BCX4208 doses evaluated in the study showed response rates ranging from 33% to 49%, compared to 18% for those taking the placebo.

At this point, Lesinurad appears the more promising of the two gout medications, and the most likely to hit the market first. It outperformed BCX4208 in early clinical trials, and is farther ahead in the development and approval process. But individual responses to drugs vary, and gout patients will benefit from having two new approaches to relieving the symptoms of this painful condition.

Gout is a form of complex arthritis and caused by many factors, including: age, diet, family history, gender, health problems, medications and weight.

In many people, gout often affects both the hands and feet, the big toe will be the most affected area in about 75% of people. It can also affect the other areas include:

- Ankle
- Elbow
- Fingers
- Heel
- Instep
- Knee
- Wrist

There are four stages for gout according to the Natural Institute of arthritis and Musculoskeletaland Skin Diseases (NIAMS):

1. Asymptomatic Hyperuricemia
In this stage, asymptomatic can be assumed as the pre-gout stage. There is a high level of uric acid in the blood but no uric acid precipitation out of blood. So, you may not feel any pain or symptoms. No gout medication and treatment is required.

2. Acute Gout, or acute Gouty Arthritis
In this stage, gout begins to harm the body. When the uric acid level within the body is getting high, and consequently, the uric acid begins to crystalize and deposit in the joint spaces. Intense pain and swelling can be caused in the affected joins. It will be a strange and sharp pain. Attacks generally happen in the evening and it may last for weeks if not treated.

3. Interval or Intercritical Gout
In this stage, there are no symptoms at the period between acute attacks. It is the time when an attack of gout has subsided. No symptoms are present because the body's immune system is stabilizing. If the patient does not get the proper gout treatment by this sage, the gout disease can develop over a long period and hard to control.

4. Chronic Tophaceous Gout
It is the worst and mot destructive stage of the disease. In this stage, the disease may have caused permanent damage to the affected joints and in some cases the kidneys as well. With proper treatment, most people with gout do not progress to this advanced stage.

Got is a painful and serious disease which can be life threatening if untreated. It is important to be diagnosed at the early stages by a physician to avoid the progress of gout. Fortunately today, most people can buy Colchicine or Ibuprofen from a lisensed Canada pharmacy online to treat gout and improve the symptoms in an effective way.

According to the investigation, no fungal elements and the black substances were found in the tablets. Hydrocarbon oil might be used in equipment for the production of tablet. It may cause the quality issues.

Almost 23-thousand boxes has been imported into Hong Kong and were supplied o HA, local pharmacies and private doctors.

So far, A Health Department spokesman said they had not received any reports of adverse affects in connection with the product.

Colchicine tablet is another alterative gout drug for the treatment of gouty arthritis and gout attacks.

New studies have shown that antidepressant medications can provide pain relief for people with arthritis as the most commonly prescribed anti-inflammatory medications (NSAIDs).

Duloxetine (brand named Cymbalta), originally used to treat depression and generalized anxiety disorder, was approved by the FDA for chronic pain treatment including osteoarthritis.

According to Arthritis UK, people with chronic arthritis diseases are twice likely to experience depression.

The antidepressant medications are effective in alleviating the painful condition and result in fewer side effects than traditionally pain killers, such as anti-inflammatory drugs. NSAIDs can lead to gastrointestinal bleeding, and opiates such as morphine , which can cause constipation.

In comparison, the most common side effects of antidepressants were less severe:

Researchers in Denmark found that patients on the strict diet for 16 weeks lost radical amounts of weight and reported a huge improvement in their pain levels, a daily reported.

A simple diet, which is very low in calories and high in protein combined with regular exercise, could end the misery of arthritis for millions of sufferers, according to new research. A relatively small weight loss can have a dramatic effect by reducing swelling, relieving pain and even helping prevent further deterioration of the joints.

"Research shows that losing weight, however modest, when combined with exercise, is a panacea at every stage," Professor Alan Silman, medical director of Arthritis Research UK, said.

"A healthy weight reduces the risk of developing the disease, relieves existing symptoms and helps to prevent further deterioration. Weight loss and exercise has been shown to achieve the same level of symptom relief as joint replacement surgery."

This is good news for gout sufferers, as a low calorie diet can be also low in purines, which will help to reduce the severity of gout flares they will experience. For the high protein, stick to beans, soy or chicken, as red meats, especially steaks and organ meats, have been known to cause flare ups.

The study participants were also placed on a regimented exercise plan, which helped them to lose the weight while still building muscle. Exercise is a great remedy for many types of arthritis, as it helps loosen up the joints, and increases blood flow and flexibility to the affected areas. The researchers involved in the study were happy to report the lessening of their patients' dependence on anti-inflammatory drugs such as generic Celebrex or generic Colcrys.

Other experts who were consulted about the study believed that the diet could be considered extreme, and would be difficult for patients to maintain in an uncontrolled environment. They did however; agree that losing weight eases pressure on joints, making arthritis pain less severe. If you are having weight or mobility issues, talk to your doctor about safe ways to starting losing weight. They may recommend seeing a nutritionist, personal trainer, or even a physiotherapist. These professionals can help you to create a fitness and nutrition regimen for yourself, and can often give you the mental tools to stick with it.

Long ago Gout was a disease of the rich, also known as the "Disease of Kings". It was known to strike the wealthy, who were the only ones who could afford rich food and wine. Over the years, access to all types of foods has improved greatly but unfortunately, episodes of gout have risen with it. Over the past few decades the number of people suffering from gout or hyperuricemia (high blood uric acid) is growing at an alarming rate. Gout affects 1-2% of the Western population at some point in their lives. Although men between the ages of 40 and 50 and post menopausal women are the most likely to develop Gout, the age group of gout patients is beginning to get younger and younger. It is becoming more common among men and women in their 30's and is beginning to show up in 20-somethings and even teenagers!

Although gout in young people is often caused by a genetic condition, patients who are overweight and have high blood pressure are at a greater risk. A study published in Arthritis Care and Research found that obese men and women are more likely to develop gout at a younger age. The researchers looked at data of over 15,000 people between the ages of 13 and 87 that were part of a larger study examining cancer and heart disease. During the follow up period, 517 people from the subset reported having developed gout. At the start of the study, 16% of the participants were obese. The study found that the onset of gout began 11 years earlier in those who were obese at the age of 21. The study also found that obese participants were almost twice as likely to develop gout over an 18 year period as non-obese participants. Other studies have shown that weight loss can reduce the risk of gout.

It's no secret that obesity in young people is on the rise. Obesity now affects 17% of all children and adolescents in the United States; triple the rate from just one generation ago. High Fructose Corn Syrup found in sugary drinks and other junk foods may be a large contributing factor to the growing obesity epidemic and has also been shown to contribute to gout. Obese youth are also at a higher risk for many diseases including high blood pressure, diabetes and gallstones to name a few. Teaching children healthy eating habits and maintaining a healthy weight could help prevent future gout attacks. Although diet may play a large role in preventing gout attacks in younger people, prescription Colchicine can help treat the pain of a current gout attack reducing inflammation caused by uric acid build up.